Job Description
Title: Coding Compliance Specialist Remote - US Remote, WA 98402, USA Job Category: Compliance Requisition Number: CODIN005364 Full-Time Remote Job Description: About Sound Founded in 2001 and headquartered in Nashville, TN, Sound Physicians is a nationally respected, physician-led medical group practicing in 400+ hospitals across 45 states. Our team of 4,000+ clinicians and 1,000+ business professionals across the country is united by one mission: to build exceptional clinical partnerships that unlock quality, affordable, dignified care for everyone – no matter who they are or where they live. With physician-led clinical teams and more than two decades of operational expertise, we’ve refined what it takes to consistently deliver exceptional care in hospital medicine, emergency medicine, critical care, anesthesia, and telemedicine. Why join us? A remote-first culture that values flexibility and collaboration Opportunities to grow your career while making a real impact A team that champions inclusivity, innovation, and excellence Whether working virtually or onsite at one of our practices, you’ll be part of a purpose-driven organization shaping the future of healthcare. Sound Physicians offers a competitive benefits package inclusive of the items below, and more: Medical insurance, Dental insurance, and Vision insurance Health care and dependent care flexible spending account 401(k) retirement savings plan with a company match Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy Ten company-paid holidays per year About the Role Under the direction of the Chief Compliance & Privacy Officer and the Director of Compliance & Audit, the ACO Compliance Specialist will coordinate and support compliance functions and activities in support of enabling Sound Long-Term Care Management Accountable Care Organization (SLTCM-ACO) providers to comply with all applicable billing and privacy compliance regulations. The ACO Compliance Specialist is responsible for conducting retrospective compliance reviews of documentation supporting codes assigned by practitioners to ensure accuracy in billing and compliance with Federal, State, payer, and institutional requirements. The ACO Compliance Specialist serves as the compliance lead and works cooperatively with SLTCM-ACO leadership and clinical leadership at ACO sites. Through the review process, the ACO Compliance Specialist also identifies opportunities to improve coding practices and related business processes or issues needing further review, assessment, and follow-up. The ACO Compliance Specialist provides individual and group coding and documentation training and works collaboratively with the Compliance Department and ACO Leadership to develop coding and documentation training materials and establishment of training plans for the practitioners in partnership with SLTCM-ACO. The ACO Compliance Specialist contributes to compliance program development by maintaining data for program reports, participating in the development and/or delivery of educational and outreach materials, and maintaining program records. The ACO Compliance Specialist will maintain current knowledge of applicable laws and regulations and may contribute to the unit’s risk assessments and risk mitigation strategies. The ACO Compliance Specialist functions as part of a unit team to accomplish unit goals and works cooperatively with other compliance staff and entity staff as needed to resolve shared issues and concerns. In addition, he or she may participate in committees, workgroups, or process improvement projects as assigned. Essential Duties and Responsibilities Perform complex coding and documentation compliance reviews of SLTCM-ACO partners in the Nursing Facility, Post-Acute Care, and Telemedicine settings using applicable rules, regulations, and coding conventions for billing to determine the accuracy of coded and billed services, including APP services where applicable. Conduct special reviews based on risk assessment activities, external or government audits, or in response to an inquiry or identified potential concern. Assess data and formulate recommendations to mitigate or resolve identified issues. Obtain, organize, and format billing and other data captured through the review process. Prepare clear, concise written reports related to the special review findings for internal and external reporting purposes; calculate refunds using a variety of methods, including extrapolation. Perform follow-up reviews to determine the status of implemented recommendations, efficacy of coding and documentation education as well as compliance with regulatory guidelines and internal policies. Report and review audit findings with Chief Medical Officer, Value Based Care for SLTCM-ACO and the Chief Compliance & Privacy Officer on a regular basis to identify trends, issues, and potential risk areas. Inform management of issues or concerns
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